Puerperal infection is an infection of the reproductive tract occurring within 28 days following childbirth or abortion. It is one of the major causes of maternal death (ranking second behind postpartal hemorrhage) and includes localized infectious processes as well as more progressive processes that may result in endometritis/metritis (inflammation of endometrium), peritonitis, or parametritis/pelvic cellulitis (infection of connective tissue of broad ligament and possibly connective tissue of all pelvic structures).
(This plan of care is an adjunct to the regular postpartal plans of care.)
CLIENT ASSESSMENT DATA BASE
Activity/Rest
Malaise, lethargy
Exhaustion and/or ongoing fatigue (prolonged labor, multiple postpartal stressors)
Circulation
Tachycardia of varying severity
Elimination
Diarrhea may be present.
Bowel sounds may be absent if paralytic ileus occurs.
Ego Integrity
Marked anxiety (peritonitis)
Food/Fluid
Anorexia, nausea/vomiting
Thirst, dry mucous membranes
Abdominal distension, rigidity, rebound tenderness (peritonitis)
Hygiene
Lack of or inadequate perineal care
Neurosensory
Headache
Pain/Discomfort
Localized pain, dysuria, abdominal discomfort
Severe or prolonged afterpains, lower abdominal or uterine pain and tenderness with guarding (endometritis)
Unilateral/bilateral abdominal pain/rigidity (salpingitis/oophoritis, parametritis)
Respiration
Rapid/shallow respirations (severe/systemic process)
Safety
Temperature: 100.4°F (38.0°C) or higher, occurring on any 2 successive days but excluding the first 24 hr postpartum, is indicative of infection; however, temperature higher than 101°F (38.3°C) in the first 24 hr is highly indicative of ensuing infection (although persistent low-grade fever during this time may also reflect infectious process).
Low-grade fever of less than 101°F (38.3°C) suggests incisional infection; fever greater than 102°F (38.8°C) is indicative of more extensive infection (e.g., salpingitis, parametritis, peritonitis).
Chills may occur; severe/recurrent chills (often lasting 30–40 min), with temperature spikes to 104°F (40.0°C), suggest pelvic infections, thrombophlebitis, or peritonitis.
Reports of internal monitoring, frequent intrapartal vaginal examinations, lapses in aseptic technique, traumatic delivery and/or lacerations of reproductive tract, operative procedures/incisions.
Preexisting infections, including human immunodeficiency virus (HIV).
Environmental exposure.
Sexuality
Premature or prolonged rupture of membranes, prolonged labor (24 hr or more).
Retention of products of conception, uterine exploration/manual removal of placenta, or postpartal hemorrhage.
Incision edges may be reddened, edematous, firm, tender, or separated, with drainage of purulent or sanguineous liquid.
Uterine subinvolution may be present.
Lochia may be foul-smelling, odorless (as in beta-hemolytic streptococci infection), scant, or profuse.
Social Interaction
Low socioeconomic status with corresponding stressors (including homelessness)
Teaching/Learning
Lack of prenatal care/postpartal follow-up
Chronic conditions; e.g., malnutrition, anemia, diabetes
DIAGNOSTIC STUDIES
White Blood Cell Count (WBC): Normal or elevated with differential shifted to the left.
Erythrocyte Sedimentation Rate (ESR), and Red Blood Cell (RBC) Count: Markedly increased in presence of infection.
Hemoglobin/Hematocrit (Hb/Hct), RBCCount: Decreased in presence of anemia.
Cultures (Aerobic/Anaerobic) of Intrauerine or Intracervical Material or Wound Drainage, or Gram’s Stain of Lochia, Cervix, and Uterus: Identify causative organism(s).
Urinalysis and Culture: Rule out UTI.
Ultrasonography: Determines presence of retained placental fragments; locates peritoneal abscess.
Bimanual Examination: Determines nature and location of pelvic pain, mass or abscess formation, or presence of thrombosed veins.
NURSING PRIORITIES
1. Control spread of infection.
2. Promote healing.
3. Support ongoing process of family acquaintance.
DISCHARGE GOALS
1. Infection resolving
2. Involution progressing, sense of well-being expressed
3. Attachment/bonding demonstrated and care of infant resumed
(This plan of care is an adjunct to the regular postpartal plans of care.)
CLIENT ASSESSMENT DATA BASE
Activity/Rest
Malaise, lethargy
Exhaustion and/or ongoing fatigue (prolonged labor, multiple postpartal stressors)
Circulation
Tachycardia of varying severity
Elimination
Diarrhea may be present.
Bowel sounds may be absent if paralytic ileus occurs.
Ego Integrity
Marked anxiety (peritonitis)
Food/Fluid
Anorexia, nausea/vomiting
Thirst, dry mucous membranes
Abdominal distension, rigidity, rebound tenderness (peritonitis)
Hygiene
Lack of or inadequate perineal care
Neurosensory
Headache
Pain/Discomfort
Localized pain, dysuria, abdominal discomfort
Severe or prolonged afterpains, lower abdominal or uterine pain and tenderness with guarding (endometritis)
Unilateral/bilateral abdominal pain/rigidity (salpingitis/oophoritis, parametritis)
Respiration
Rapid/shallow respirations (severe/systemic process)
Safety
Temperature: 100.4°F (38.0°C) or higher, occurring on any 2 successive days but excluding the first 24 hr postpartum, is indicative of infection; however, temperature higher than 101°F (38.3°C) in the first 24 hr is highly indicative of ensuing infection (although persistent low-grade fever during this time may also reflect infectious process).
Low-grade fever of less than 101°F (38.3°C) suggests incisional infection; fever greater than 102°F (38.8°C) is indicative of more extensive infection (e.g., salpingitis, parametritis, peritonitis).
Chills may occur; severe/recurrent chills (often lasting 30–40 min), with temperature spikes to 104°F (40.0°C), suggest pelvic infections, thrombophlebitis, or peritonitis.
Reports of internal monitoring, frequent intrapartal vaginal examinations, lapses in aseptic technique, traumatic delivery and/or lacerations of reproductive tract, operative procedures/incisions.
Preexisting infections, including human immunodeficiency virus (HIV).
Environmental exposure.
Sexuality
Premature or prolonged rupture of membranes, prolonged labor (24 hr or more).
Retention of products of conception, uterine exploration/manual removal of placenta, or postpartal hemorrhage.
Incision edges may be reddened, edematous, firm, tender, or separated, with drainage of purulent or sanguineous liquid.
Uterine subinvolution may be present.
Lochia may be foul-smelling, odorless (as in beta-hemolytic streptococci infection), scant, or profuse.
Social Interaction
Low socioeconomic status with corresponding stressors (including homelessness)
Teaching/Learning
Lack of prenatal care/postpartal follow-up
Chronic conditions; e.g., malnutrition, anemia, diabetes
DIAGNOSTIC STUDIES
White Blood Cell Count (WBC): Normal or elevated with differential shifted to the left.
Erythrocyte Sedimentation Rate (ESR), and Red Blood Cell (RBC) Count: Markedly increased in presence of infection.
Hemoglobin/Hematocrit (Hb/Hct), RBCCount: Decreased in presence of anemia.
Cultures (Aerobic/Anaerobic) of Intrauerine or Intracervical Material or Wound Drainage, or Gram’s Stain of Lochia, Cervix, and Uterus: Identify causative organism(s).
Urinalysis and Culture: Rule out UTI.
Ultrasonography: Determines presence of retained placental fragments; locates peritoneal abscess.
Bimanual Examination: Determines nature and location of pelvic pain, mass or abscess formation, or presence of thrombosed veins.
NURSING PRIORITIES
1. Control spread of infection.
2. Promote healing.
3. Support ongoing process of family acquaintance.
DISCHARGE GOALS
1. Infection resolving
2. Involution progressing, sense of well-being expressed
3. Attachment/bonding demonstrated and care of infant resumed
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